The Affordable Care Act Strengthens New York

David R. Jones, The Urban Agenda

The Affordable Care Act (ACA), also known as “Obamacare,” goes fully into effect next year.  While most people who get their health insurance through their employment or government programs will keep their coverage, for millions of others - who don’t or can’t afford insurance from their employers, or are uninsured and unemployed – the new federal health care reform law is a blessing.

Many Uninsured

Approximately 2.7 million New Yorkers are uninsured.  Many are low- and moderate-income working people who are not offered job-based coverage and cannot afford to buy insurance on their own.  Many others are effectively stopped from buying insurance.  In some states, insurers reject applicants with past medical problems such as diabetes and hypertension.  New York has long barred this practice and, as a result, has had a very expensive individual insurance market.

Obamacare will eliminate health-based discrimination by insurance carriers, make health insurance more affordable, and reduce the growth of health care spending.  For those with low- and moderate incomes (earning less than $94,200 for a family of four), there will be government subsidies to help pay for insurance.  But, contrary to what opponents of the ACA want consumers to believe, nobody is going to go broke being forced to buy insurance under the law.

With the ACA in effect, 1.1 million New Yorkers – many of them black and Latino residents – are expected to newly gain affordable insurance.  This will mean better public health, as there will be fewer people walking around ill but too poor to afford a doctor.  Also, there will likely be fewer uninsured people going to hospital emergency rooms when they are ill instead of to a family doctor.  Each year, emergency room costs for treating the uninsured add up to billions of dollars of hidden costs that are shifted to taxpayers, government, and commercial entities.

The ACA has already made a difference in the lives of many New Yorkers.  When a family’s daughter – not covered by insurance - got sick just as she was launching her own small business, they learned that because of the ACA, she could enroll in her father’s health plan.  The family – once faced with having to refinance the house to pay for their daughter’s care – no longer needs to worry.

When a single mother’s child got very sick, she took her to the hospital.  Afterwards, the bill was almost $700.  The hospital had a financial assistance program, but she was unable to get information from the hospital about how to apply.  With help from the local Community Health Advocates (CHA) agency, a program of the Community Service Society, her financial aid application was filed and her bill was reduced to $25.  CHA also found that her daughter was eligible for coverage under Child Health Plus insurance and helped her enroll in a plan.

CHA is New York State’s designated health consumer assistance program, providing help in access to coverage.  Its statewide network has helped with problems ranging from finding affordable insurance to filing grievances and appeals when things go wrong.  

Health Exchanges

Federally subsidized health insurance exchanges, or insurance marketplaces, have been set up in 17 states to administer the ACA.  New York is one of them, leading the way in establishing a model Exchange that will make getting health coverage consumer-friendly for the first time.  When New York’s Health Benefit Exchange opens on October 1, 2013, consumers will be able to compare health insurance plans, enroll in Medicaid or apply for subsidies to buy commercial coverage.  And the state’s small businesses will be able to apply for $220 million in tax credits to provide insurance to their employees.

However, some people are too poor to afford coverage even with government subsidies.  They were supposed to be covered by a federally financed expansion of Medicaid.  But the Supreme Court, in its decision upholding the constitutionality of the ACA, granted the states the right to opt out of expanding Medicaid.  As a result, in some states where Republican governors have blocked Medicaid expansion, the poorest of the poor will be left without coverage.

Ironically, many of the states that have refused to expand Medicaid have the highest percentage of uninsured residents. That includes Texas, where about a quarter of the residents are uninsured.  Besides Texas, 25 other states with Republican governors have refused to set up exchanges altogether, thereby leaving the task to the federal government.

Under New York’s Exchange, costs for individual and family coverage will drop by 66 percent; costs for small business coverage will drop by five to 22 percent.  New York has also expanded its Medicaid program to ensure that low-income residents can get coverage.

Governor Cuomo provided a vision for health coverage as well as a model for the rest of the nation.  New York’s Exchange is unique in that it will have “no wrong door” – enrolling New Yorkers into public or private coverage, depending on their income.  It will even help certain immigrants access the Emergency Medicaid program.  Most importantly, it will make it possible for more New Yorkers to access proper health insurance for themselves and their families.